Maybe why so many VA denials ( VA OIG)

[Berta]

https://www.va.gov/oig/pubs/VAOIG-20-00421-63.pdf

[brokensoldier244th]

I don’t know the breakdown of GS levels in our RO, but reading through that it looks like the testing and recertification only occurred at GS10 and higher. I’m a 7, so I’ve not even heard of this.
 

All my training was over about 2.5 months of 8 hour days followed by ‘supervised release’ where every action I took was approved or not by a gs10 or another mentor. That was another 8 weeks with 12 allotted if necessary. My claims work (and everyone else’s) is evaluated 2-3 times each month from a randomized pool of un examined claims and errors scored. There is a percentage threshold in order to be considered successful. For my rating the minimum to be considered successful is 83% though that would result in remedial training,  and I’m currently at about 94% right now for correct actions taken. Its a slidinging scale that resets ever fiscal year. For the first 50 claims (tasks reviewed) it's pretty lenient but as the number of claims you work goes up so does the threshold required to meet or excel through the year. We get evaluated both on 'quality' (number of errors or not) and 'production' (number of claims worked) among other things, and each count separately during performance reviews.

Edited March 4, 2021 by brokensoldier244th

[El Train]

Does anybody know if they hold C&P examiners accountable? Like if someone files an NOD, submits additional evidence from a treating physician, or forensic doctor who performs an in person DBQ or IME exam; scrutinizing an inadequate C&P exam & coming to a different conclusion.  Maybe just a flat out piss poor exam because they didn't care for a Vet's attitude (don't piss of a C&P examiner in other words).  They should if they don't.  Especially if the claim gets approved or increased after being initially denied or low rating.  Especially if the C&P examiner has a formal VARO complaint against them and subsequent C&P's find in favor of the Vet and their exam as 'not making any sense' based on treatment records.

[brokensoldier244th]

I don't know about that- I identify, when I can, lack of opinions, seemingly incongruent rationales, etc, and before I send to rate I send those to a separate team of raters that do a review of it first and if im right, they kick it back to me to either do a rework or to reschedule the exam with someone else- sometimes in person, sometimes a records review. I don't scrutinize every NP or Dr that does the exams but I do look at a few things.

The names of some doctors are well known for doing DBQs on the fly. Others, where the veteran lives in AZ and the examiner lives in Missouri (example only, not based on anything) get scrutinized by me- usually by looking up their name to see if they are running a website DBQ mill, or, sometimes if it doesn't look too sketchy or if they have received treatment from that VAMC in the past (or maybe they recently moved and the address hasn't been updated yet) Ill mail/call the veteran to ask them. I don't make any final decisions on things like that but I DO try to submit them to the ratings or review team to take a closer look. I have some medical training for taking apart exams and medical notes transcriptions-both on my own and through work, but there are other teams that do nothing but that all day so I get their opinion about it. 

 

Thats about the best I can tell you from my limited POV on the ground. 

[broncovet]

I have heard those "90 to 95% accuracy" at the VARO numbers before.  So, please explain why, at the BVA, about 3/4 of the appeals are remanded or reversed?    That is a pretty big discrepency..5 to 10 percent in accurate, to 75 percent errors found by the board which required a remand or better.  

Of course, not every "bad" claim is appealed to the board, more are appealed to HLR or SCL, not to mention Cue.  Further, the board has errors also, and some of those are reveresed at the CAVC.  

So, please explain this apparently discrepency:  90 to 95% of the claims that leave the VARO, are correct, but, only about 25% to 30 percent of those are correct when they reach the BVA?  This makes no sense.  

ONE obvious possibiliity:  "The error checks" at the VARO level are inaccurate, also.  Or, maybe most of the claims that leave the VARo are "not checked" for accuracy at all?"  

What am I missing here?  

Source:  Bva Chairmans report

https://www.bva.va.gov/Chairman_Annual_Rpts.asp

Scroll down (pick the year!) to statistics, where it explains about 75 percent of claims adjuticated by the Board are in accurate enough to warrant a remand or reversal.  

 

Edited March 4, 2021 by broncovet

[brokensoldier244th]

I didn’t say that was the RO’s average, I said it was mine. Big difference. I’m not going to try to explain it because I’m one person and I can’t control the RO average, nor the fact that while the BVA may be right on many things, they can weasel word things sometimes, too, that boggle the mind. I do what I do and I’m not going to argue with people about it. 
 

that 75% is a subset, also, and is a small part of the total claims filed every year.